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目的:评价侧卧位B超引导下微创经皮肾镜取石术(mPCNL)治疗强直性脊柱炎合并肾结石的疗效及安全性。方法:强直性脊柱炎合并肾结石患者23例,男18例,女5例,平均年龄45(31~72)岁。结石位于左肾14例,右肾9例。单发5例,多发4例,部分铸型结石8例,全铸型结石6例。肾结石平均直径33(23~54)mm。均行侧卧位B超引导下mPCNL治疗。结果:23例手术患者B超引导下均穿刺成功,行微通道气压弹道碎石术。Ⅰ期结石取净19例(83%),Ⅱ期取净4例(17%)。Ⅰ期mPCNL平均手术时间72(45~136)min。术后血红蛋白下降量为18.5(16.3~20.7)g/L,术后气胸1例,未发生结肠损伤、严重出血、尿外渗及肾周感染等并发症。平均住院时间8(7~11)d。结论:侧卧位B超引导下mPCNL治疗强直性脊柱炎并发肾结石,患者能更好地耐受手术,同时便于麻醉管理,避免了X线照射,是一种值得推荐的安全、有效方法。
OBJECTIVE: To evaluate the efficacy and safety of minimally invasive percutaneous nephrolithotomy (mPCNL) in the treatment of ankylosing spondylitis complicated with renal calculi under lateral ultrasound. Methods: Twenty-three patients with ankylosing spondylitis and nephrolithiasis, 18 males and 5 females, average age 45 (31-72) years old. Stones in the left kidney in 14 cases, 9 cases of right kidney. Single in 5 cases, multiple in 4 cases, part of the cast stone in 8 cases, all cast stone in 6 cases. The average diameter of kidney stones 33 (23 ~ 54) mm. All patients underwent lateral ultrasound B-guided mPCNL treatment. Results: Twenty-three surgeries underwent B-ultrasound guided puncture. Micro-channel pneumatic lithotripsy was performed. Stage Ⅰ stones were removed in 19 cases (83%), stage Ⅱ net taken in 4 cases (17%). Stage I mPCNL average operation time 72 (45 ~ 136) min. Postoperative hemoglobin decreased 18.5 (16.3 ~ 20.7) g / L, postoperative pneumothorax in 1 case, no colonic injury, severe bleeding, exudation of urine and perirenal infection and other complications. The average length of stay 8 (7 ~ 11) d. Conclusion: The treatment of ankylosing spondylitis complicated with kidney stones by mTB-guided mPCNL in lateral position is a safe and effective way to tolerate surgery and facilitate anesthesia management and avoid X-ray irradiation.